Selective method for identification and quantification of Bifidobacterium animalis subspecies lactis BB-12 (BB-12) from the gastrointestinal tract of healthy volunteers ingesting a combination probiotic of BB-12 and Lactobacillus rhamnosus GG.

AIM: To develop a novel validated method for the isolation of Bifidobacterium animalis ssp. lactis BB-12 (BB-12) from faecal specimens and apply it to studies of BB-12 and Lactobacillus rhamnosus GG (LGG) recovered from the healthy human gastrointestinal (GI) tract. METHODS AND RESULTS: A novel method for isolating and enumerating BB-12 was developed based on its morphologic features of growth on tetracycline-containing agar. The method identified BB-12 correctly from spiked stool close to 100% of the time as validated by PCR confirmation of identity, and resulted in 97-104% recovery of BB-12. The method was then applied in a study of the recovery of BB-12 and LGG from the GI tract of healthy humans consuming ProNutrients® Probiotic powder sachet containing BB-12 and LGG. Viable BB-12 and LGG were recovered from stool after 21 days of probiotic ingestion compared to baseline. In contrast, no organisms were recovered 21 days after baseline in the nonsupplemented control group. CONCLUSIONS: We demonstrated recovery of viable BB-12, using a validated novel method specific for the isolation of BB-12, and LGG from the GI tract of healthy humans who consumed the probiotic supplement. SIGNIFICANCE AND IMPACT OF THE STUDY: This method will enable more detailed and specific studies of BB-12 in probiotic supplements, including when in combination with LGG.

Maternal and neonatal outcomes for pregnancies before and after gastric bypass surgery.

BACKGROUND: Interaction between maternal obesity, intrauterine environment and adverse clinical outcomes of newborns has been described. METHODS: Using statewide birth certificate data, this retrospective, matched-control cohort study compared paired birth weights and complications of infants born to women before and after Roux-en-Y gastric bypass surgery (RYGB) and to matched obese non-operated women in several different groups. Women who had given birth to a child before and after RYGB (group 1; n=295 matches) and women with pregnancies after RYGB (group 2; n=764 matches) were matched to non-operated women based on age, body mass index (BMI) prior to both pregnancy and RYGB, mother's race, year of mother/s birth, date of infant births and birth order. In addition, birth weights of 13 143 live births before and/or after RYGB of their mothers (n=5819) were compared (group 3). RESULTS: Odds ratios (ORs) for having a large-for-gestational-age (LGA) neonate were significantly less after RYGB than for non-surgical mothers: ORs for groups 1 and 2 were 0.19 (0.08-0.38) and 0.33 (0.21-0.51), respectively. In contrast, ORs in all three groups for risk of having a small for gestational age (SGA) neonate were greater for RYGB mothers compared to non-surgical mothers (ORs were 2.16 (1.00-5.04); 2.16 (1.43-3.32); and 2.25 (1.89-2.69), respectively). Neonatal complications were not different for group 1 RYGB and non-surgical women for the first pregnancy following RYGB. Pregnancy-induced hypertension and gestational diabetes were significantly lower for the first pregnancy of mothers following RYGB compared to matched pregnancies of non-surgical mothers. CONCLUSION: Women who had undergone RYGB not only had lower risk for having an LGA neonate compared to BMI-matched mothers, but also had significantly higher risk for delivering an SGA neonate following RYGB. RYGB women were less likely than non-operated women to have pregnancy-related hypertension and diabetes.

Complications following replantation of a primary incisor: a cautionary tale.

The replantation of avulsed primary incisors is contra-indicated. This case describes an 8-year-old child who six years previously had avulsed and had replanted a primary central incisor. At presentation, this tooth was retained, the permanent successor had failed to erupt and appearance of the adjacent lateral incisor was notably delayed. Investigation revealed a radicular cyst in relation to the replanted deciduous incisor together with severe displacement of the permanent tooth, which could not be saved.

Management of diabetic patients requiring nutritional support.

A retrospective analysis was performed on 70 patients with diabetes mellitus who required nutritional support over the 10-yr period 1979-1989. Information was available for 65 patients, of whom 55 had non-insulin-dependent diabetes mellitus (NIDDM). Enteral nutrition (EN, 750-2200 kcal/day) was given to 40 NIDDM patients (group A) and 6 insulin-dependent diabetic (IDDM) patients (group B), and parenteral nutrition (PN, 1600-2400 kcal/day) was given to 18 NIDDM patients (group C) and 4 IDDM patients (group D). Three NIDDM patients required both types of feeding. Preadmission diabetes treatment remained the same during feeding for 31% of the total group (38% of group A, 33% of group B, 23% of group C, and 0% of group D). The NIDDM patients in group C who received insulin during PN required a high daily dose of approximately 100 U. The IDDM patients on PN required an increase of 225% from their preadmission daily dose. The likelihood of a patient requiring a major change from preadmission diabetes therapy depended mainly on the severity of the underlying illness and on the type of feeding (greater with PN) but not on preadmission therapy, age of patient, or type of EN (cyclic vs. continuous). Hypoglycemic episodes were uncommon in all groups. There were no significant differences between the prefeeding and feeding blood glucose levels and HbA1c results.

Interrelationship between dental age and chronological age in Somali children.

OBJECTIVE: To compare dental age (DA) with chronological age (CA) in Somali and white Caucasian children, resident in Sheffield. DESIGN: Cross-sectional study. SETTING: Paediatric dentistry clinic, Charles Clifford Dental Hospital, Sheffield. SUBJECTS: Somali children under 16 years of age and age- and gender-matched white Caucasian subjects. OUTCOME MEASURES: Dental age was determined for each subject, using their existing panoramic radiographs. Comparisons of the difference between dental age and chronological age (DA-CA) were made for gender and ethnic group, using independent sample t tests at the 0.05 level of significance. RESULTS: The sample group comprised 162 subjects: 84 Somali and Caucasian boys (mean age 10.55 years) and 78 Somali and Caucasian girls (mean age 11.24 years). The mean difference between DA and CA was found to be 1.01 years for Somali boys, 0.19 years for Caucasian boys, 1.22 years for Somali girls, and 0.52 years for Caucasian girls. The difference between DA and CA was significantly greater in Somali subjects than in Caucasian children. A few Somali subjects showed a marked discrepancy between chronological age and dental age (range -1.75 to 5.42 years), which was most evident in 8- to 12-year-old children. CONCLUSION: Somali children are significantly more dentally advanced than their Caucasian peers. This finding highlights the need for population-specific dental development standards for accurate dental age assessment.

Operational criteria for the determination of suicide.

Suicide is an important public health problem for which we have an inadequate public health database. In the United States, decisions about whether deaths are listed as suicides on death certificates are usually made by a coroner or medical examiner. These certification decisions are frequently marked by a lack of consistency and clarity, and laws and procedures for guiding these decisions vary from state to state and even from county to county. Without explicit criteria to aid in this decision making, coroners or medical examiners may be more susceptible to pressures from families or communities not to certify specific deaths as suicide. In addition, coroners or medical examiners may certify similar deaths differently at different times. The degree to which suicides may be underreported or misclassified is unknown. This makes it impossible to estimate accurately the number of deaths by suicide, to identify risk factors, or to plan and evaluate preventive interventions. To remedy these problems, a working group representing coroners, medical examiners, statisticians, and public health agencies developed operational criteria to assist in the determination of suicide. These criteria are based on a definition of suicide as "death arising from an act inflicted upon oneself with the intent to kill oneself." The purpose of these criteria is to improve the validity and reliability of suicide statistics by: (1) promoting consistent and uniform classifications; (2) making the criteria for decision making in death certification explicit; (3) increasing the amount of information used in decision making; (4) aiding certifiers in exercising their professional judgment; and (5) establishing common standards of practice for the determination of suicide.

Reye's syndrome and analgesic choice in dentistry.

In the light of recent warnings on the hazards of aspirin administration to children, a survey amongst the parents of 361 randomly selected child dental out-patients, aged 11.99 years and under, was undertaken to determine their analgesic of choice for the relief of dental pain. A significant number of parents are continuing to administer aspirin to children under 12 years of age, contrary to medical advice. The choice of a suitable alternative analgesic is discussed.

Trends in exodontia under general anaesthesia at a dental teaching hospital.

AIMS: To survey the use of simple exodontia for children under general anaesthesia on an out-patient basis at a Northern Dental Hospital. To monitor any effects resulting from the introduction of the Poswillo guidelines on the referral for and treatment of patients under general anaesthesia. DESIGN: A retrospective longitudinal analysis. SETTING: A Northern Dental Hospital in England. MATERIALS: Information was recorded from original case records of children undergoing exodontia under general anaesthesia on an out-patient basis during October between 1989 and 1997. RESULTS: The mean and modal age of the children decreased from 7.7 years to 6.0 years respectively in 1989 to 5.7 years and 4.0 years in 1997. The proportion receiving a general anaesthetic for orthodontic extractions substantially decreased from 18.0% in 1989 to 0.7% in 1997 and the need for repeat dental general anaesthetics within 18 months was eliminated with the introduction of a pre-general anaesthetic screening service. CONCLUSION: Dental treatment under general anaesthesia should continue to be available where it is justified. A separate assessment appointment reduces the prescription of general anaesthesia and minimises its usage for orthodontic extractions and the necessity for repeat general anaesthesia.

Caries experience and dental attendance of Somali children living in a British city.

AIM: To facilitate the planning of future dental services, this study sought baseline data, relating to caries experience and dental attendance, for Somali children resident in Sheffield, UK. METHODS: A convenience sample of 4 to 14 year old Somali children was drawn from pupils attending Somali religious education classes, youth groups and selected schools in Sheffield. During 1998 and 1999, 238 Somali children were subjected to a dental examination and a structured interview. RESULTS: The mean age of the study population was 9.4 years with equal male and female distribution. The majority of children (58%) had been born in Somalia compared with 29% in the UK or 13% in another country. Just over half of the sample had English-speaking mothers. The mean dmft for 4 to 6 year olds was 2.12 and 50% demonstrated a past caries experience. In the 7 to 10 year old group, mean dmft was 2.05 and caries had again affected 50% of subjects. Mean DMFT for 11 to 14 year olds was 1.37 and 58% showed evidence of previous caries experience. The mother's reported ability to speak English was a strong predictor of caries experience in the group as a whole. Interestingly, an English-speaking mother was associated with low caries prevalence in young children, but with high caries prevalence in children over the age of 7 years. Finally, only 57% of subjects had seen a dentist within the previous 12 months, and almost half of these visits had been prompted because of a specific problem. CONCLUSION: It is evident that some Somali children have a high caries experience, with mother's ability to speak English being the greatest predictor of dental disease. Preventive strategies need to be developed for this population and regular dental attendance should be encouraged.

The aesthetic management of severe dental fluorosis in the young patient.

The prevalence of dental fluorosis appears to be on the increase. Although in its mild form the condition is not considered to be of cosmetic significance, the more severe forms can cause great psychological distress to the affected individual. This article discusses the prevalence and mechanisms of dental fluorosis, and the aesthetic management of severe fluorosis in the young patient.

Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults: a randomized double-blind placebo-controlled trial.

BACKGROUND/OBJECTIVES: Live-attenuated influenza vaccine (LAIV) protects against influenza by mucosal activation of the immune system. Studies in animals and adults have demonstrated that probiotics improve the immune response to mucosally delivered vaccines. We hypothesized that Lactobacillus GG (LGG) would function as an immune adjuvant to increase rates of seroconversion after LAIV administration. SUBJECTS/METHODS: We conducted a randomized double-blind placebo-controlled pilot study to determine whether LGG improved rates of seroconversion after administration of LAIV. We studied 42 healthy adults during the 2007-2008 influenza season. All subjects received LAIV and then were randomized to LGG or placebo, twice daily for 28 days. Hemagglutinin inhibition titers were assessed at baseline, at day 28 and at day 56 to determine the rates of seroconversion. Subjects were assessed for adverse events throughout the study period. RESULTS: A total of 39 subjects completed the per-protocol analysis. Both LGG and LAIV were well tolerated. Protection rates against the vaccine H1N1 and B strains were suboptimal in subjects receiving LGG and placebo. For the H3N2 strain, 84% receiving LGG vs 55% receiving placebo had a protective titer 28 days after vaccination (odds of having a protective titer was 1.84 95% confidence interval 1.04-3.22, P=0.048). CONCLUSION: Lactobacillus GG is potential as an important adjuvant to improve influenza vaccine immunogenicity. Future studies of probiotics as immune adjuvants might need to specifically consider examining vaccine-naïve or sero-negative subjects, target mucosal immune responses or focus on groups known to have poor response to influenza vaccines.

Extraction of first permanent molar teeth: results from three dental hospitals.

OBJECTIVE: To evaluate and compare the reasons for and pattern of extraction of first permanent molars (FPMs) in three UK dental hospitals. DESIGN: Prospective multicentre study. SETTING: Hospital. SUBJECTS: Three hundred children attending Manchester Dental Hospital, Liverpool Dental Hospital and Charles Clifford Dental Hospital (Sheffield) who required extraction of at least one FPM. RESULT: The mean age in months was 129 (SD 22.7), 139 (SD 29.4), and 133 (SD 26.8) for Manchester, Liverpool and Sheffield respectively. Forty-five percent and 48% of children had four FPMs extracted at Manchester and Sheffield respectively, compared to 25% in Liverpool. The main reason for extraction was caries with poor prognosis (70%); molar incisor hypomineralisation was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used in 77%, 55%, and 47% of cases in Manchester, Liverpool and Sheffield respectively. Sixty-eight percent of cases had not received previous treatment for the FPMs and 5% had fissure sealants detected. Forty percent of children had had previous extractions. CONCLUSION: The children who are attending the hospitals for extraction of FPMs tend to be older than the recommended age for achieving spontaneous space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk.

Rhabdomyosarcoma of the mandible in a 6-year-old boy.

INTRODUCTION: Rhabdomyosarcoma is an aggressive malignant tumour composed of neoplastic mesenchymal cells that infiltrate surrounding tissue structures, making their precise site of origin unclear. Although rare, this is highly aggressive and the most common soft-tissue neoplasm of the head and neck in children. Regrettably by the time most cases are initially seen, the patients already have large tumours, due to rapid tumour growth and delayed medical consultation. CASE REPORT: This report describes a 6-year-old presenting with just such symptoms of facial swelling and pain but elicitation of further information and findings, including tooth mobility of 3 days duration, led to prompt referral and early treatment of an embryonal rhabdomyosarcoma. CONCLUSION: General dental practitioners are frequently presented with a child with a swollen face and pain. Experience would suggest a dental abscess to be the most likely cause with treatment as appropriate. However, all swellings in children, should be thoroughly investigated and reviewed as particularly in this age group, tumour growth is rapid while early diagnosis allows successful treatment with multimodality therapy.

'Ilko dacowo:' canine enucleation and dental sequelae in Somali children.

OBJECTIVE: To assess the prevalence of primary canine enucleation and associated dental sequelae in Somali children resident in Sheffield. DESIGN: Cross-sectional survey. SETTING: Somali religious education classes and homework groups, selected primary and secondary schools, and the Charles Clifford Dental Hospital, Sheffield (1998-99). SUBJECTS AND METHODS: The target population were all Somali children aged between 4 and 17 years. Subjects were interviewed to obtain background sociodemographic data and an oral examination was performed. The status of the canine in each quadrant was noted, in addition to the presence of any dental anomalies in adjacent teeth. Features indicative of a history of attempted canine enucleation included: absence of primary canines, localized developmental defects affecting primary or permanent canines and lower lateral permanent incisors, and retention of lower primary lateral incisors with distal eruption of permanent lateral incisors. RESULTS: A total of 260 children were included in the study, comprising 56.5% of the target population. The mean age of the subjects was 9.7 years with an equal male and female distribution. According to the criteria devised, 82 (31.5%) of the subjects were considered to exhibit one or more of the dental features suggestive of a previous history of canine enucleation. There was no significant difference in prevalence according to gender or birthplace (UK, Somalia or another country), but a positive history was greater in subjects whose mother did not speak English. In addition to anomalies involving canines, lower permanent incisors were commonly missing (5.0% of children aged over 9 years). CONCLUSION: The suspected continuation of canine enucleation in UK-born Somali children raises important oral health issues. Culturally sensitive education is indicated to discourage this harmful ritual practice.

Papillon-Lefèvre syndrome: a report of two cases.

Papillon-Lefèvre syndrome is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. It is transmitted as an autosomal recessive condition and consanguinity of parents is evident in about one-third of cases. This paper describes two preschool children who presented at the Paediatric Dentistry Department, Sheffield, UK, with progressively loosening teeth and discomfort during eating. The medical history revealed scaling on the hands and feet, which had been medically diagnosed as eczema. Papillon-Lefèvre syndrome was diagnosed in both cases.

Schinzel-Giedion syndrome: interesting facial and orodental features, and dental management.

Schinzel-Giedion syndrome comprises multiple congenital anomalies. The orofacial features include coarse facies, frontal bossing, ocular hypertelorism, anterior open bite and macrodontia. Two cases are presented in which the presence of specific craniofacial anomalies with bilateral hydronephrosis confirmed the diagnosis. In one patient, bottle-feeding was associated with caries in maxillary central and lateral incisors, but the second patient was permanently tube fed and did not experience any dental caries. Clinical management of these patients requires a coordinated approach from a team of medical and dental specialists.

The emergence of youth suicide: an epidemiologic analysis and public health perspective.

In this epidemiologic analysis, we examine death certificate data to identify significant patterns and trends in suicide in the United States. Although the overall suicide rate did not change from 1950 to 1980, fundamental and important changes did occur: suicide rates among older persons decreased and rates among younger persons increased markedly. Suicide rates have increased most dramatically among young white men aged 15 to 24. From 1950 to 1980, rates among white males aged 15 to 19 increased by 305%; among white males aged 20 to 24, by 196%. The percentage of suicides in which firearms were used has also increased markedly, most dramatically in young men and women. These fundamental changes in the pattern of suicide in the United States have critical implications for how the mental health and public health communities approach the problem. Suicide has traditionally been considered a mental health problem, and our approach to prevention was based on a portrait of the typical suicidal individual as an older, depressed, white male. The basic prevention strategy involved detection and treatment of depression. If, as some recent research suggests, most young persons at high risk for suicide are not depressed, the whole approach to prevention must be reexamined. There is an urgent need to reexamine and advance our understanding of what causes suicide. Who are the persons at greatest risk, and what can be done to prevent these deaths? Although increased use of drugs and alcohol has been proposed as a possible cause of the increase in suicides, it is only one hypothesis among others that must be examined. The significance of mental illness, suicide clusters and contagion, and the availability of firearms need further study as possible risk factors for youth suicide. Suicide represents the second leading cause of death among young persons aged 15 to 24. A problem of this magnitude should be given high priority by the public health community in planning and implementing research and interventions.

Ruminal infusion of ammonium chloride in lactating cows to determine effect of pH on ammonia trapping.

Milking rations containing 16 (control), 13.2, and 10.4% protein were fed to four midlactation, rumen-fistulated Holstein cows. Ammonium chloride was infused ruminally for 5 consecutive days after morning feeding when cows were fed milking rations containing 13.2 and 10.4% protein. Amount infused was equivalent to the ammonia in 1 or 2% dietary urea. Rumen and blood samples were taken prior to and following morning feedings. Intake of milking ration was the same across treatments. Initial rumen pH was higher for ammonium chloride treatments. It then declined, as did the control, to the same, lowest pH at 1.5 to 3 h postfeeding. Rumen ammonia increased rapidly for cows receiving both ammonium chloride treatments to .5 h postfeeding and then declined rapidly. Blood urea nitrogen was highest for cows fed the control ration, peaked .5 h postfeeding for cows infused with the low ammonium chloride, then dropped and peaked again 6 h postfeeding. Blood ammonia was highest among treatments for control cows and differed by sampling time only for control cows with a peak .5 h postfeeding. Because lower rumen pH traps ammonia preventing rapid absorption into blood, interpretation of high rumen ammonia must consider effect of rumen pH.